Medical - Inpatient Hospital Services

exam room

Includes medical, mental health and maternity services.

Inpatient Service

In-Network Provider1,2

Non-network Provider3

Semi-Private Room

Pays 90% of network rates1,2

50% of non-network rates3

Lab Tests, X-rays & Imaging

Pays 90% of network rates1,2

50% of non-network rates3

General supplies

Pays 90% of network rates1,2

50% of non-network rates3

Nursing services

Pays 90% of network rates1,2

50% of non-network rates3

Medication

Pays 90% of network rates1,2

50% of non-network rates3

Physicians & Specialists

Pays 90% of network rates1,2

50% of non-network rates3

Surgery

Pays 90% of network rates1,2

50% of non-network rates3

1Inpatient admissions: $250 co-pay per inpatient admission.

2Inpatient hospital services are subject to the $300 deductible (per plan year).

3Inpatient hospital services with non-network providers are subject to a $500 deductible per admission. 

Inpatient hospital care in connection with childbirth will be covered for at least 48 hours following a normal delivery (96 hours following a cesarean section).